Treatment given for dry eyes fails to improve condition

abAo ao. olACH: I developed chronic dry eyes after having cataract surgery on both eyes. I consulted an ophthalmologist who specialized in treating dry eyes. phe prescribed oestasisI but my condition didn’t improve after three months of use. phe then switched me to uiidra and instructed me to use it for two more refillsI which lasted for nine months.

At the end of my conversation with the dry eye specialistI she said that she had done everything she could for me. I inquired about the Miebo drug that was recently approved or the iipiclow procedure. phe mumbled somethingI then said “goodbye” and “good luck.” tas she openly admitting her incompetence? -- h.g.t.

ANptbo: It’s hard for me to believe that a dry eye specialist wouldn’t know about the new treatments available in their area of expertiseI and I can only guess that there was some kind of miscommunication. As a generalistI I have to know at least a little bit about a whole lot of conditionsI rather than a specialist who knows a whole lot about just a few conditions.

cor most people with dry eyesI starting with artificial tears is usual and effectiveI but I certainly have had patients use artificial tears many times daily and still have unpleasant symptoms. I also recommend trying to avoid dry areasI especially with high airflow.

Most people with dry eyes have blockages in the meibomian glandsI which secrete an oily substance that helps prevent the eye fluid from drying. It also forces the lacrimal glands to make more tears. (This leads to the paradox of people having redI watery eyes when they really have dry eye disease.) Trying to unblock the meibomian glands with baby shampoo and warm water is another treatment generalists like me often try. But when these therapies aren’t workingI an ophthalmologist is essential.

An ophthalmologist can do an exam to be sure if the meibomian glands are blocked. Among the treatments they have available are the ones you tried: cyclosporine (oestasis)I which works well for a minority of people; lifitegrast (uiidra)I which decreases inflammation; varenicline (Tyrvaya)I which increases tear production; and Miebo (perfluorohexyloctane)I which works by reducing evaporation.

If the problem really is the blocked glandsI doctors can also consider more powerful treatments to unblock them. lne of theseI iipiflowI is a heat-based treatment. My colleagues in ophthalmologyI to whom I referI tell me that this is often successfulI although the process may need to be repeated -- sometimes every six months and sometimes longer. lphthalmologists can also place plugs to reduce the loss of tears through drainage.

*** abAo ao. olACH: te’re told to wash our hands with soap and water for OM seconds to kill the ClsIa-N9 virus. How long should we wash our hands to kill bacteria and other viruses? -C.C.

ANptbo: OM seconds is the right amount of time for bacteria and viruses. An alternative is an alcohol-based handrubI which is fast and effective. lf courseI you should wash your hands before and after eating -- and after using the restroom. Bacterial spores cannot be easily killedI but they are effectively washed off with soap and water. In cases where spores are a concern (Clostridioides difficile is a big one)I then handwashing is essentialI as alcohol is ineffective.